MGMA Physician Practice Assessment: Medicare Quality Reporting Programs Survey Report. October 2014

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Adam Pitts
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1 MGMA Physician Practice Assessment: Medicare Quality Reporting Programs Survey Report October 2014

2 Overview Medical Group Management Association (MGMA) conducted member research in October 2014 to better understand physician practices experiences with Medicare Part B quality reporting programs and how they ve impacted practice operations and overall quality improvement for Medicare beneficiaries. The survey includes responses from more than 1,000 medical groups in which more than 48,000 physicians practice nationwide is a critical year for medical group practices participating under three main Medicare Part B quality reporting programs: Physician Quality Reporting System (PQRS), the meaningful use EHR Incentive program and the Value-Based Payment Modifier. It will be the first year all three programs penalize physicians for unsuccessful reporting. When added up, unsuccessful reporting in 2015 will subject physicians and other eligible providers to Medicare payment penalties as high as 11%, levied in future years. 2

3 Summary of Findings MGMA noted four main themes within the findings. Practices are already engaged in quality improvement 83% of survey respondents reported that their practice is actively engaged in internal clinical quality improvement processes, regardless of any federal requirements. 77% of survey respondents reported that their practice uses evidence-based clinical protocols to ensure the delivery of high quality patient care, regardless of any federal requirements. Medicare s quality reporting programs are not enhancing the quality of care delivered While these programs are intended to improve the quality of care physicians provide to their patients, the majority of respondents reported that these programs actually detract from patient care. 84% of survey respondents reported that Medicare s quality reporting programs do not enhance their physicians ability to provide high quality patient care. 85% of survey respondents reported that Medicare s quality reporting programs have had a negative impact on clinician productivity. Only 12% of survey respondents reported that Medicare s quality reporting programs have had a positive impact on clinical decision-making. These programs actually distract from providing patient care. Our physicians are so concerned with checking the right boxes to collect data and ensuring they are meeting these requirements, that they are unable to give their full attention to patient care. We have not seen any correlation between quality of care and compliance with these programs. In fact, it takes time away from patient care and adds dramatically to paperwork/computer time for both the clinical and billing side of the practice. Our providers find themselves spending more time worrying about whether or not they are doing everything correctly to meet all the requirements to the detriment of time they have with the patient and their medical issues. 3

4 Medicare s quality reporting programs are negatively impacting practice resources Practices face a number of challenges complying with complex program requirements and practice resources are being stretched dangerously thin. 76% of survey respondents reported that Medicare s quality reporting programs have had a negative or a significant negative impact on their practice resources. Additionally: 84% reported a negative or a significant negative impact to practice efficiency 93% reported a negative or significant negative impact to support staff time 85% reported a negative or significant negative impact to clinician morale The minor benefits of some of the features are far outweighed by the enormous amount of resources required to comply with all the requirements. The adjusted workflows, increased administrative and clinical burden, and excessive amount of time and energy spent on these programs have created a very negative atmosphere. Participation in these programs utilizes a great deal of time, energy, and financial resources. We have had to hire more staff just to do the paperwork required. 4

5 Practices are concerned for 2015 Practices are very concerned with their ability to successfully participate in Medicare s quality reporting programs in % of survey respondents reported they are concerned with their ability to participate in these programs in Regarding 2015 program participation: 81% of survey respondents reported they are very or extremely concerned with the regulatory complexity of programs 75% of survey respondents reported they are very or extremely concerned about the lack of relevance to specialty care 76% of survey respondents reported they are very or extremely concerned with overall implementation costs 75% of survey respondents reported they are very or extremely concerned about unattainable program requirements/thresholds It is very discouraging to put so much time and resources into submitting for the program only to find out that we are getting a penalty. It makes us really re-think The amount of administrative time and energy going into this program is not sustainable in the long term. The fact that all of these programs are geared towards primary care makes the already difficult and complex requirements close to impossible for specialty practices. The lack of relevance to our specialty is especially frustrating and shocking. For us and our patients, almost all of the "medical improvement initiatives" dreamed up by the federal government over the last several years for the stated goals of improving patient care, bringing down healthcare costs, etc. have had the exact opposite effect. In my opinion, these initiatives are so far detached from reality that they are farcical. 5

6 Conclusion In light of the many concerns practices have regarding their ability to be successful with these Medicare quality reporting programs and the considerable strain they place on practices, significant changes should be made to these programs. The complexity of these programs, and resulting physician frustration, has reached an all-time high. They present an untenable situation for physician practices who are forced to focus internal resources on government reporting, rather than patient care. MGMA calls on CMS to support, not punish, physician practices. The agency should take immediate action to truly harmonize Medicare quality initiatives. Medicare s focus should be on meaningful quality improvement efforts that provide timely, actionable feedback aimed improving patient care. 6

7 1. Does your practice actively engage in internal clinical quality improvement processes (regardless of any federal requirements)? Answer Options Response Yes 82.7% No 14.4% Do not know 2.9% 2. Does your practice use evidence-based clinical protocols to ensure the delivery of high quality patient care (regardless of any federal requirements)? Answer Options Response Yes 77.3% No 15.4% Do not know 7.2% 7

8 3. Does your practice currently participate in any Medicare Part B quality reporting programs? (PQRS, Meaningful Use, Value-Based Payment Modifier) Answer Options Response Yes 91.1% No 8.4% Do not know 0.5% For those that answered Yes : 4. Please rate your overall experience with Medicare quality reporting programs: Very negative Negative Neutral Positive Very positive 17.5% 36.3% 33.8% 11.3% 1.1% 5. Overall, how would you rate the regulatory complexity of Medicare quality reporting programs? Not at all complex Slightly complex Moderately complex Very complex Extremely complex 0.8% 4.4% 24% 38.5% 32.2% 8

9 6 Do you believe Medicare s quality reporting programs enhance your physicians ability to provide high quality patient care? Answer Options Response Yes 10.2% No 83.9% Do not know 5.8% 7. How would you rate the feedback received from Medicare quality reporting programs in helping physicians in your practice improve patient care? Very ineffective Ineffective Neutral Effective Very effective 29.5% 38.3% 27.6% 4% 0.5% 9

10 8. How would you assess the impact Medicare quality reporting programs has on the following in your practice? Answer Options Overall quality of patient care Significant negative impact Negative impact No impact Positive impact Significant positive impact 7% 20.9% 57.7% 13.5% 1% Patient satisfaction 6.8% 26.1% 60.1% 6.4% 0.6% Clinical decisionmaking 3.6% 10.8% 73.2% 11.9% 0.5% Financial stability 23.5% 38.7% 27.8% 9.7% 0.2% Practice resources 31.9% 44.1% 19.9% 3.8% 0.2% Support staff time 47.4% 44.8% 6.5% 1% 0.4% Clinician productivity 30.8% 54.1% 12.9% 2% 0.2% Practice efficiency 31.1% 52.6% 12.2% 3.9% 0.2% Clinician morale 39.1% 45.7% 13.8% 1.2% 0.1% 10

11 9. Are you concerned with your practice s ability to successfully participate in Medicare quality reporting programs in 2015? Answer Options Response Yes 73.6% No 22.2% Do not know 4.2% 11

12 10. For the following issues, please rate your degree of concern regarding your practice s ability to successfully participate in Medicare quality reporting programs in 2015: Answer Options Lack of vendor readiness Inadequate time for our practice to prepare Unattainable program requirements/ thresholds Not at all concerned Slightly concerned Moderately concerned Very concerned Extremely concerned 10.1% 21.9% 24.3% 23.1% 20.6% 2% 13.6% 23.3% 32.1% 29% 0.8% 6.9% 17.5% 34.2% 40.6% Regulatory complexity 0.7% 3% 15.5% 37.4% 43.3% Lack of timely feedback 1.9% 8% 25.6% 31.6% 32.9% Unclear program guidance Conflicting program requirements Overall implementation costs Lack of clinical relevance Lack of relevance to specialty care 1% 6% 17.8% 34.6% 40.6% 2.7% 9.6% 19.9% 32.8% 35% 0.8% 6.4% 16.7% 27.7% 48.4% 1.2% 9.1% 17.1% 31.6% 41% 3.7% 6.3% 15.2% 23.8% 51% 12

13 11. Would you support a single harmonized Medicare quality improvement initiative that standardizes reporting across all programs? Answer Options Response Yes 71.5% No 3.1% Do not know 25.5% 13

14 PPA Demographics Participation Total 1,005 practices in which over 48,000 physicians practice State All but one state participated: North Dakota Practice Size Mean 25.6 FTE physicians Median 8 FTE physicians Organization Type Independent medical practice 72.3% Hospital or integrated delivery system (IDS), or medical practice owned by hospital of IDS 17.7% Medical school faculty practice plan or academic clinical science department 4% Federally qualified health center, community health center or similar practice 0.7% Freestanding ambulatory surgery center (ASC) 0.3% 14

15 PPA Demographics (cont.) Specialty Total: 42 specialties participated Highest participation by specialty 1. Multispecialty with primary and specialty care 20.8% 2. Orthopedic surgery 9.5% 3. Family practice 9.5% 4. Ob/gyn 6.5% 5. Cardiology 4.3% 6. Multispecialty with specialty care only 4% 7. Gastroenterology 3.9% 8. Internal medicine 3% 9. Anesthesiology 2.9% 10. Dermatology 2.9% 15

16 About MGMA The Medical Group Management Association (MGMA) helps create successful medical practices that deliver the highest-quality patient care. As the leading association for medical practice administrators and executives since 1926, MGMA helps improve members practices through exclusive member benefits, education, resources, news, information, advocacy, and networking opportunities, and produces some of the most credible and robust medical practice economic data and data solutions in the industry. Through its industry-leading ACMPE board certification and Fellowship programs, MGMA advances the profession of medical practice management. Through its national membership and 50 state affiliates, MGMA represents more than 33,000 medical practice administrators and executives in practices of all sizes, types, structures and specialties. MGMA is headquartered in Englewood, Colo., with a Government Affairs office in Washington, D.C. Contact MGMA Government Affairs: govaff@mgma.org, Contact MGMA Media Relations: lboten@mgma.org, , ext. 1332

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